Challenge 15

Nasogastric Feeding and Drainage Tube Placement and Verification

A nasogastric or NG tube is a plastic tubing device that allows delivery of nutrition directly into the stomach (feeding), or removal of stomach contents (drainage). It is passed via the nose into the oropharynx and upper gastrointestinal tract. Many times these tubes can be malpositioned, leading to significant harm and even death. The National Health Service Improvement (NHSI) in the United Kingdom has placed this type of incident on their “never events” list; never events are “errors in medical care that are identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility.” (National Quality Forum)

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Statistics

Thousands of feeding tubes are inserted daily without incident. However, there is a small risk that the nasogastric feeding tube can be misplaced into the lungs during insertion, or move out of the stomach at a later stage. In 2009, feeding into the lung from a misplaced nasogastric tube became a “never event” in England.1
1.

NHS Salisbury. (2011). Insertion and Care of Nasogastric Tubes. (Cited 2011 March).

In studying over 2,000 feeding tube insertions, Sorokin et al. (2006) determined 1.3 to 2.4 percent of NG tubes were malpositioned and 28 percent of those resulted in respiratory complications (e.g. pneumonia, pneumothorax).2
2.

Children’s Hospital Association, Child Health Patient Safety Organization. (2012). A Patient Experienced a SERIOUS SAFETY EVENT. (cited 2012 August).

Between 2005 and 2011 the NPSA was notified of 21 deaths and 79 cases of harm due to misplaced NG tubes.3
3.

Medical Protection. (2012). Nasogastric Tube Errors. (cited 2012).

Every year, nearly 500,000 nasogastric (NG) and percutaneous endoscopic gastrostomy (PEG) tubes and suction tubes are misplaced, which result in severe complications or death.4
4.

AHC Media. (2015). Misplaced NG tubes a major patient safety risk. (cited 2015 April 1).